Eating in SINC : Oral Feeding on CPAP and Beyond

Eating in “SINC”: Oral Feeding on CPAP and Beyond Stacey Dalgleish, MN, NNP Eating in “SINC” Oral Feeding on CPAP and Beyond Winnipeg, April 2015 A...
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Eating in “SINC”: Oral Feeding on CPAP and Beyond

Stacey Dalgleish, MN, NNP

Eating in “SINC” Oral Feeding on CPAP and Beyond Winnipeg, April 2015

A Quality Improvement Project Calgary Zone NICUs

Presenter Disclosure  Stacey Dalgleish, MN, NNP  Alberta Health Services  No conflicts  No potential conflicts of interest

2 Canadian Association of Neonatal Nurses – ONE Day of Education Monday, April 13, 2015 9:15 a.m. – 10:00 a.m.

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Eating in “SINC”: Oral Feeding on CPAP and Beyond

Stacey Dalgleish, MN, NNP

Presentation Objectives •Describe eating as a developmental task. •Review relationship between eating and breathing. •Define “SINC” as a QI construct to safely guide the initiation and advancement of oral feeding. •Illustrate examples of neonates fed safely using “SINC” strategies. •Share outcome data from a “SINC” cohort

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Calgary Zone  1.1 million  referral area southern Alberta

5 NICUs •123 beds •650 nurses •28 Neonatologists …at least that many opinions

4 Canadian Association of Neonatal Nurses – ONE Day of Education Monday, April 13, 2015 9:15 a.m. – 10:00 a.m.

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Eating in “SINC”: Oral Feeding on CPAP and Beyond

Stacey Dalgleish, MN, NNP

Calgary Status 2012 

 No Auditing

  

 Safety concerns  Oral feeding while on CPAP



 Developmental concerns



 Missing opportunities for feeding skill acquisition

 Long term burden of oral aversion  No local data

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Optimal Lung Practices  Prolonged CPAP to ensure FRC  Historical culture to withhold oral feeding on CPAP  Advancing technology, increasing knowledge

 Feedback regarding delayed feeders  Rapid PDSA Cycles (Spring 2012)   

? Remove CPAP for feeding practice ? High Flow NP ?Discontinue CPAP at 36 weeks

 All unsuccessful: Loss of FRC, no endurance, delayed feeding success

6 Canadian Association of Neonatal Nurses – ONE Day of Education Monday, April 13, 2015 9:15 a.m. – 10:00 a.m.

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Eating in “SINC”: Oral Feeding on CPAP and Beyond

Stacey Dalgleish, MN, NNP

Baby G. 27 weeks in 2012 Feeding pattern 37-39 weeks CGA (99 feeds) 12

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38 weeks 6 lpm HF, 0.28

Volume (mLs)

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37 weeks CPAP +6 0.21-0.24

39 weeks 5 lpm HF, 0.28

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0 1 3 5 7 9 111315171921232527293133353739414345474951535557596163656769717375777981838587899193959799

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Quality Improvement Question?  Can we help babies born at

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